A Retrospective Review of Mercaptopurine Metabolism Reveals High Rate of Patients with Suboptimal Metabolites Successfully Corrected with Allopurinol

Lauren M. Vasta; Richard C. Zanetti; Dina S. Parekh; Anne B. Warwick; Kenneth Lieuw

doi:10.1097/MPH.0000000000001939

A Retrospective Review of Mercaptopurine Metabolism Reveals High Rate of Patients with Suboptimal Metabolites Successfully Corrected with Allopurinol

Lauren M. Vasta, Richard C. Zanetti, Dina S. Parekh, Anne B. Warwick, Kenneth Lieuw^*

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

11 Scopus citations

Abstract

Skewed drug metabolism of 6-mercaptopurine (6-MP) can jeopardize antileukemic effects and result in toxicities during the treatment of acute lymphoblastic leukemia and lymphoblastic lymphoma. Allopurinol can alter 6-MP metabolism to maximize therapeutic effects while reducing toxicities. Over 75% of our patients with acute lymphoblastic leukemia or lymphoblastic lymphoma experienced a 6-MP-related toxicity. Review of metabolite date a showed 6-methylmercaptopurine nucleotide levels were >10,000 in 55% of the cohort, suggesting 6-MP shunting. Allopurinol was initiated in 12 of 23 shunters with resolution of toxicities. We propose an algorithm to incorporate allopurinol into chemotherapy regimens for patients with inappropriate 6-MP metabolism.

Original language	English
Pages (from-to)	E1003-E1009
Journal	Journal of Pediatric Hematology/Oncology
Volume	43
Issue number	7
DOIs	https://doi.org/10.1097/MPH.0000000000001939
State	Published - 1 Oct 2021

Keywords

6-mercaptopurine
acute lymphoblastic leukemia
allopurinol
pediatric
young adult

Access to Document

10.1097/MPH.0000000000001939

Cite this

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title = "A Retrospective Review of Mercaptopurine Metabolism Reveals High Rate of Patients with Suboptimal Metabolites Successfully Corrected with Allopurinol",

abstract = "Skewed drug metabolism of 6-mercaptopurine (6-MP) can jeopardize antileukemic effects and result in toxicities during the treatment of acute lymphoblastic leukemia and lymphoblastic lymphoma. Allopurinol can alter 6-MP metabolism to maximize therapeutic effects while reducing toxicities. Over 75% of our patients with acute lymphoblastic leukemia or lymphoblastic lymphoma experienced a 6-MP-related toxicity. Review of metabolite date a showed 6-methylmercaptopurine nucleotide levels were >10,000 in 55% of the cohort, suggesting 6-MP shunting. Allopurinol was initiated in 12 of 23 shunters with resolution of toxicities. We propose an algorithm to incorporate allopurinol into chemotherapy regimens for patients with inappropriate 6-MP metabolism.",

keywords = "6-mercaptopurine, acute lymphoblastic leukemia, allopurinol, pediatric, young adult",

author = "Vasta, {Lauren M.} and Zanetti, {Richard C.} and Parekh, {Dina S.} and Warwick, {Anne B.} and Kenneth Lieuw",

year = "2021",

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language = "English",

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A Retrospective Review of Mercaptopurine Metabolism Reveals High Rate of Patients with Suboptimal Metabolites Successfully Corrected with Allopurinol. / Vasta, Lauren M.; Zanetti, Richard C.; Parekh, Dina S. et al.
In: Journal of Pediatric Hematology/Oncology, Vol. 43, No. 7, 01.10.2021, p. E1003-E1009.

Research output: Contribution to journal › Review article › peer-review

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T1 - A Retrospective Review of Mercaptopurine Metabolism Reveals High Rate of Patients with Suboptimal Metabolites Successfully Corrected with Allopurinol

AU - Vasta, Lauren M.

AU - Zanetti, Richard C.

AU - Parekh, Dina S.

AU - Warwick, Anne B.

AU - Lieuw, Kenneth

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AB - Skewed drug metabolism of 6-mercaptopurine (6-MP) can jeopardize antileukemic effects and result in toxicities during the treatment of acute lymphoblastic leukemia and lymphoblastic lymphoma. Allopurinol can alter 6-MP metabolism to maximize therapeutic effects while reducing toxicities. Over 75% of our patients with acute lymphoblastic leukemia or lymphoblastic lymphoma experienced a 6-MP-related toxicity. Review of metabolite date a showed 6-methylmercaptopurine nucleotide levels were >10,000 in 55% of the cohort, suggesting 6-MP shunting. Allopurinol was initiated in 12 of 23 shunters with resolution of toxicities. We propose an algorithm to incorporate allopurinol into chemotherapy regimens for patients with inappropriate 6-MP metabolism.

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